? JDSMAN {er ongeterm core Advocates for the Elderly ‘Mid-Cumberland Human Resouree Agency 4101 Kermit Drive, Suite 300 Nashville, TN: 37217 61 (STATEMENT OF AGREEMENT BETWEEN VOR AND DISTRICT ‘OMBUDSMAN ‘As aVOR, | agree to: 1 ‘Adhere to te policies, procedures and guideines of the Long Term Care Ciibudsman Program as set fort inthe training manual a Pete utente nm VOR i een eS A 3 abies sum raining requirements as set forth inthe VOR Job deserter f Full min pervsion from and be accountable tothe District Ompusan: Exercise my responsibilties in accordance with the VOR code of ethics. ‘As District Ombudsman, | agree to: 4. Train VOR as required for certification; 3. Provide eupport and supervision through maintaining reguiar| contact with VOR as follows: = quarterly in-service = phone contact as frequently as needed: 3, Assist VOR as needed with investigation and resolution of specific ‘complaints: 4 a annual review with the VOR of job satisfaction and performance, ‘This VOR was ___ certified! _recertified on. . (Check one) (Date) Shona othor: 0 Z Volunteer Ombudsman ‘Representative Program rict Ombuds to} 5] 200. Date $a see